HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - a61(� Permit Number:
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Building Permit Application DEC /2 AS
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR;POD
EK
Address:
Address: otV3_ Ct N)E Kkk Q5 1 ST b PT S-� V kkCA e-- 34.q$ 3 (1 10
Legal Description:
Property Tax ID#: eAkq -5-1 b 0 Q9"I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Q00 �4 . Q40 to 7 Y
Additional work to be pertormed under this permit-c eck all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof ( � P-
,Total Sq.Tt_of Construction,) Sq. Ft. of First Floor:
Cost;of Construction;_$ �J Utilities: _Sewer _Septic Building Height:
§fN
ame �j iPNA �.�W 1 S Name:
Address: QL6q NE 1V%�N S4 \ ST Company:
City:�e>el S"V `A«_QAe- State:`i:-1 Address:
Zip Code:3403 1-1.10 Fax: City: State:
Phone No. 1_(a, VI q-b 340 Zip Code: Fax:
E-Mail: lecN�SAW\�. `Pa I�Ou. COM Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S'U�PPLE�M�E�N AL C®NSTR�U' TI® LIEN LAW I: F®RI�/.IATi.®:N:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: tSC- Name:
Address:.``1 $L4 S. W -T nIZ� S�C: N Address:
City: `VhRa ST "e State:`71-1 City: State:
Zip: 3146N4 Phone tCjt 2, _J%5 q Rc6g Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
signature•of-Owrier/`Lessee ontractor as Age . Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF Yva COUNTY OF
m<
The forgoing instrument was acknowledged befThe forgoing instrument was acknowledged before me
this day of (ae ,20/ by Q_ this day of ,20_ by
NP3
fP
x
(Name of person acknowledging) LLP
N` (Name of person acknowledging)
.,
(Signature of�rry Public-State of Flori a) (Signature of Notary Public-State of Florida)
Personally Knowp� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ` Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE 'MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014